- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,332.29 / $9,774.00 / $14,552.94
| Facility | | $2,332.29 | $9,774.00 | $14,552.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $784.50 / $3,955.65 / $3,955.65
| Professional | | $784.50 | $3,955.65 | $3,955.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,002.38 / $2,565.40 / $3,651.50
| Professional | | $2,002.38 | $2,565.40 | $3,651.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.50 / $3,955.65 / $5,537.91
| Facility | | $784.50 | $3,955.65 | $5,537.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,033.78 / $2,440.53 / $4,954.55
| Professional | | $2,033.78 | $2,440.53 | $4,954.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,876.25 / $4,011.04 / $5,052.00
| Professional | | $2,876.25 | $4,011.04 | $5,052.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.50 / $3,955.65 / $5,537.91
| Facility | | $784.50 | $3,955.65 | $5,537.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,193.34 / $3,964.40 / $5,104.00
| Professional | | $1,193.34 | $3,964.40 | $5,104.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,052.32 / $4,104.64 / $4,515.10
| Professional | | $2,052.32 | $4,104.64 | $4,515.10 |